Utilization Review Registered Nurse Case Manager

PRIMARY PURPOSE: To provide services for dedicated units. To evaluate the need for alternative services as appropriate. To assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's health needs. To promote quality cost-effective outcomes through communication and available resources. and to provide quality, cost effective alternatives to acute care. -Delivers utilization review services; i.e., administrative continued stay review. -Evaluates need for alternative treatment through telephonic contact and assessment with service provider. -Negotiates price, level of care, intensity and duration with providers. -Documents findings, implements alternative care, continues to evaluate medical necessity of frequency, intensity and length of care with physicians and agency/vendors. -Maintains accurate record system of Utilization Review to include cost savings and data collection. -Adheres to quality assurance standards. -Interacts and coordinates work of Physician Advisors as necessary. -May perform review of cases to identify referral for case management. -Supports the Total Performance Management initiative.Requirements Education & Licensing: -Baccalaureate degree from an accredited college or university preferred -RN licensure required -CPUR or equivalent certification preferred -Utilization Review Work Experience required-1+ years clinical experience-Workman's compensation experience preferredExperience: Minimum Two (2) to Three (3) years of clinical practice experience required